Introduction
What Postpartum Depression Is
Postpartum depression is different for everyone and although it has some of the characteristics of other types of disorders – such as anxiety, posttraumatic stress, bipolar, and obsessive-compulsive disorder, it often appears different from these disorders (Rosenberg & Windell, 2009). It is characterized by women feeling like they’re enveloped in darkness for months after childbirth or even during pregnancy. Women who suffer from this disorder lose their sense of self as a new mother and a woman. They have terrible thoughts about their baby and are afraid to talk about these. Moreover, they think that having a baby is a mistake and wish that they can undo things. As well, they feel that they might lose the love of the people around them because they are not good enough at caring for their baby.
Effects of Postpartum Depression on Child Development
A mother who suffers from postpartum depression interacts differently with her child compared to the way that a healthy mother would. As such, research indicates that postpartum depression can affect a child’s development, behavior, and health (Kotin, 2011). Although not all children experience problems as a result of their mother’s depression, research shows that children – particularly boys – of mothers with postpartum depression don’t perform as well on cognitive tasks (e.g. language) as the children of healthy mothers (Kotin, 2011). Moreover, the infants of depressed mothers tend to spend more time crying and fussing than other infants. On the other hand, the infants of intrusive depressed mothers cry less but tend to avoid engaging with their mothers or looking at them. As well, the insecure attachments of infants to their depressed mothers during the late infancy stage can have negative effects when the infant reaches the childhood stage. These negative effects can include hyperactive symptoms; high rates of conduct problems, especially among boys; and anxiety. In addition, postpartum depression can affect the way that the mother uses healthcare resources, which consequently affects the child’s health. In particular, the infants of depressed mothers tend to visit the emergency department more frequently than infants of healthy mothers and they tend to receive less preventive healthcare, such as immunizations.
Although most mothers recover from the baby blues on their own, it is still best to seek medical help and treatment as this disorder can come in severe forms, such as postpartum depression, postpartum anxiety, and postpartum psychosis. In this regard, this paper discusses some of the treatments that are available for postpartum depression and how efficient these treatments are.
Materials and Methods
For the purpose of this research, a review of the existing research will be conducted in order to determine the available treatments for postpartum depression, their efficiency, and their effect on child development. For this review, the researcher will use journal articles, books, and other scholarly sources.
Discussion
Although medication is traditionally the first-line treatment for postpartum depression, studies suggest that therapy may be a better choice (Phillips, 2011). In a meta-analysis conducted by researchers from the University of Iowa, it was found that psychotherapy should be considered the first-line of treatment for postpartum depression instead of as a supplement to medication (Philips, 2011). While medication is helpful when needed, many women end up taking the wrong medication or taking it even when they don’t need it. Moreover, using medication as the first-line of treatment deprives these women of the opportunity to consider other options, especially since some women would like to avoid taking medications, particularly when they are pregnant or are nursing. For some women, having a place to talk and receive coping strategies is enough for them to be treated.
In this regard, individual psychotherapy was found to be effective in four randomized controlled trials, particularly those conducted by Appleby and colleagues in 1997; Cooper and Murray in 1997; Holden and colleagues in 1989; and O’Hara and colleagues in 2000 (Gjerdingen, 2003). Studies also showed that better results were achieved when the women’s partners participated in several of the psychotherapy sessions, as these women obtained lower Edinburgh Postnatal Depression Scores (Gjerdingen, 2003).
According to Leitch (2002), the Interpersonal Therapy (IPT), “is the best studied psychotherapeutic treatment for women with postpartum depression” (Leitch, 2002, p. 12). This form of therapy addresses both the interpersonal relationship disruptions and the depressive symptoms caused by postpartum depression. It consists of both cognitive-behavioral counseling and non-directive counseling. The former consists of giving advice about ways to improve one’s mood, about practical support, and about childcare while the latter involves supportive listening without intervention or advice. In a study that tested the efficacy of this treatment method, the results showed a dramatic decrease in the participants’ depressive symptoms after twelve weeks, which implied that this form of therapy can be an effective alternative to medication, especially when the mother is breastfeeding (Leitch, 2002).
On the other hand, the clinical trials conducted to determine the effectiveness of group therapy showed mixed results, which could be attributed to the differences in the structure and content of the group therapy sessions. These included the trials conducted by Chen and colleagues in 2000; Fleming and colleagues in 1992; and Meager & Milgrom in 1996 (Gjerdingen, 2003).
If medication is needed then antidepressant treatment can be employed, as antidepressant drugs have been found to be effective in the treatment of general depression (Gjerdingen, 2003). However, despite newer antidepressants -- such as the selective serotonin reuptake inhibitors (SSRIs) -- having the same level of effectiveness as the older TCAs (tricyclic antidepressants), doctors prefer SSRIs for the treatment of depression because of their relative safety in the event of an overdose and because of their greater tolerability (Gjerdingen, 2003). The side effects of SSRIs include increased sweating, sexual dysfunction, drowsiness, insomnia, nervousness, anxiety, headache, diarrhea, anorexia, and nausea while the side effects of TCAs include orthostatic hypotension, sedation, weight gain, and anticholinergic effects (Gjerdingen, 2003).
For the treatment of postpartum depression, in particular, uncontrolled studies have found antidepressants to alleviate postpartum depressive symptoms after the intake of antidepressant drugs such as venlafaxine, fluvoxamine, and sertraline (Gjerdingen, 2003). However, since it’s possible to recover from depression over time even without treatment, it cannot be determined for certain whether the depressive symptoms improved because of the drugs or because of other factors. Nevertheless, the findings of a controlled study indicated that antidepressant drug therapy was effective in the treatment of postpartum depression (Gjerdingen, 2003). In particular, the results of this study showed that the participants who took fluoxitone achieved better results than those who did not and that those who attended six counseling sessions showed more improvement than those who attended only one session (Gjerdingen, 2003). However, the study showed that the combination of the antidepressant treatment with the multiple counseling sessions had no added benefit.
For mothers who are breastfeeding while undergoing antidepressant drug treatment, studies have shown that the serum levels of the antidepressant drugs in infants were either very low or undetectable (Gjerdingen, 2003). There were very few instances when the mother’s intake of such drugs had adverse effects on the infant. In one instance, there were relatively high levels of nefazodone in the infant and in three other instances, there were very high levels of fluoxetine in the infants (Gjerdingen, 2003). The adverse effects in these infants included colic, diarrhea, vomiting, and increased crying. Moreover, the infant with a high level of fluoxetine experienced decreased sleep while the infants with high levels of nefazodone experienced poor feeding, hypothermia, lethargy, and drowsiness. In addition, adverse effects were seen in infants whose mothers took doxepin and citalopram.
However, although antidepressant treatment poses risks for the child, not being treated for depression also poses risks for both the mother and the child. As such, the risks and the potential benefits of the treatment must be carefully considered. In the event that the potential benefits outweigh the risks, experts recommend starting out the drug treatment with nortriptyline, sertraline, and paroxetine, as no adverse effects on the infants have been observed from the mother’s intake of these drugs (Gjerdingen, 2003). In contrast, experts recommend avoiding the intake of fluoxetine and being cautious with the intake of nefazodone, doxepin, and citalopram, as these drugs have been found to have adverse effects on infants (Gjerdingen, 2003). Experts further suggest starting the treatment with SSRI as it is easy to administer and contains a low level of toxicity (Gjerdingen, 2003). They also recommend continuing this treatment for six to eight weeks upon the positive response of the patient (Gjerdingen, 2003). Moreover, they recommend continuing intake at the same dose for at least six months after the patient achieves full remission (Gjerdingen, 2003). Still, hormonal treatment can be administered as childbirth causes dramatic hormonal shifts in women. In particular, the daily administration of transdermal 17β-estradiol has been found to result in the decrease of depressive symptoms while estrogen therapy had also been shown to effectively treat postpartum psychosis (Gjerdingen, 2003). However, progesterone was determined to be ineffective in treating postpartum depression and could even have negative effects. Similarly, more research is necessary in determining the safety in employing estrogen therapy as treatment, as increased estrogen can cause thromboemboli or decreased milk production in breastfeeding mothers (Gjerdingen, 2003).
Finally, nurse home visits are another effective treatment for postpartum depression. In particular, studies in Europe showed that weekly counseling visits by a clinic nurse to provide support for depressed mothers resulted in a higher rate of postpartum depression recovery where 80% of those who received counseling visits recovered while only 25% of those who did not receive counseling visits recovered (Gjerdingen, 2003). Similar positive outcomes were also obtained from another nurse home visit program where the nurse facilitated the mother’s access to community services, provided guidance on problems with childcare, and reinforced successes (Gjerdingen, 2003).
Conclusion
This paper briefly described postpartum depression and its adverse effects on both the mother and the child. In the discussion of the possible treatments for this disorder, it was shown that both psychotherapy and drug treatment are effective methods of treatment. However, since drug treatment carries some risks for both the mother and the child, especially when the mother is breastfeeding, experts suggest that psychotherapy be used as a front-line treatment for postpartum depression as not all mothers who are suffering from this disorder need medication and so that they can be provided with alternative options before considering medication.
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References
Gjerdingen, D. (2003, September-October). The effectiveness of various postpartum depression
treatments and the impact of antidepressant drugs on nursing infants. Journal of the
American Board of Family Practice, 16(5), 372-382.
Kotin, G. (2011). A pediatrician’s perspective. In S. S. Bennett (2011), Postpartum depression
for dummies. Hoboken, NJ: John Wiley & Sons.
Leitch, S. (2002, December). Postpartum depression: A review of the literature. St. Thomas,
Ontario: Elgin-St. Thomas Health Unit.
Phillips, M. L. (2011). Treating postpartum depression. Monitor on Psychology, 42(2), 46-48.
Rosenberg, R. & Windell, J. (2009). Conquering postpartum depression: A proven plan for
recovery. Cambridge, MA; Da Capo Press.
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